What expenses are not reimbursed for medical insurance?

Rural cooperative medical insurance

(1) Reimbursement scope:

1. Drug expenses: supplementary examination: 2 yuan for examination expenses such as ECG, X-ray fluoroscopy, radiography, laboratory test, physiotherapy, acupuncture, CT and nuclear magnetic resonance; Operation expenses (refer to national standards, and those exceeding 1 yuan will be reimbursed by 1 yuan).

2. The elderly over 6 years old are hospitalized in Xingta Town Health Center, and the treatment and nursing expenses are compensated to 1 yuan every day, with a limit of 2 yuan.

(2) It does not belong to the scope of reimbursement:

1. Self-seeking medical treatment (no designated hospital for medical treatment or no referral form), self-purchased drugs, drugs that cannot be reimbursed according to the regulations of free medical care and medical expenses that are not in line with family planning;

2. Outpatient treatment fee, visiting fee, hospitalization fee, meals fee, accompanying fee, nutrition fee, blood transfusion fee (except for those with family blood storage, which shall be reimbursed according to relevant regulations), cooling and heating fee, ambulance fee, special nursing fee and other expenses;

3. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents;

4. Orthopedics, plastic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consultation fees, etc.

5. Within the scope of reimbursement, beyond the limit.

employee medical insurance

scope of medical treatment items covered by basic medical insurance

(1) medical treatment equipment and medical materials

1. Application of X-ray computed tomography (CT), stereotactic radiation devices (γ-knife, χ-knife), cardiac and angiographic X-ray machines (including digital subtraction equipment) and nuclear magnetic resonance * *.

2. extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;

3. Pacemakers, artificial joints, artificial lenses, artificial organs replaced by vascular stents, and materials placed in the body;

4. Disposable medical materials that can be charged separately as stipulated by the provincial price department.

(2) Treatment items

1. Hemodialysis and peritoneal dialysis;

2. Transplantation of kidney, heart valve, cornea, skin, blood vessel, bone and bone marrow;

3. Cardiac laser drilling, anti-tumor cellular immunotherapy and fast neutron therapy.

4, hearing AIDS and other rehabilitation devices;

5. Various self-use health care, massage, examination, rehabilitation and treatment devices.

(3) Treatment items

1. Organ source or tissue source of various organ transplants or tissue transplants;

2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;

3. Orthopedic surgery for myopia;

4. qigong therapy, music therapy, health-care nutritional therapy, magnetic therapy and other auxiliary treatment projects.

(4) Other

1. Diagnosis and treatment items of various infertility (pregnancy) and sexual dysfunction;

2. Various scientific research and clinical verification diagnosis and treatment projects;

1. Scope of medical treatment items for which basic insurance does not pay

(1) Service items

1. Registration fee, consultation fee outside the hospital, medical record fee, etc.

2. Special medical services, such as visiting fees, urgent fees for examination and treatment (except emergency), additional fees for roll call surgery, high quality and good price fees, and fees for self-invited special nurses.

(2) Non-disease treatment items

1. Various beauty (life beauty, medical beauty) bodybuilding items, as well as disorderly non-functional plastic surgery and orthopedic surgery;

2. Various weight loss, weight gain and height increase projects;

3. Various physical examinations;

4. Various preventive and health care diagnosis and treatment projects; Registration fee, consultation fee outside the hospital, medical record fee, etc.;

5. Special medical services such as visiting fees, urgent fees for examination and treatment (except emergency), surcharge for roll call operation, high quality and good price fees, and fees for self-invited special nurses.

(2) Non-disease treatment items

1. Various beauty (life beauty, medical beauty) bodybuilding items, as well as disorderly non-functional plastic surgery and orthopedic surgery;

2. Various weight loss, weight gain and height increase projects;

3. Various physical examinations;

4. Various preventive and health care diagnosis and treatment projects;

5. Orthodontics and porcelain;

6. All kinds of medical consultation (excluding psychiatric consultation) and medical appraisal.

(3) Diagnosis and treatment equipment and medical materials

1. Use positron emission tomography, electron beam CT, ophthalmic excimer laser therapeutic equipment and other large medical equipment for examination and treatment projects;

2. Rehabilitation appliances such as glasses, dentures, artificial eyes, artificial limbs and hearing AIDS;

3. Various self-use health care, massage, examination, rehabilitation and treatment devices.

(4) Treatment items

1. Organ sources or tissue sources of various organ transplants or tissue transplants;

2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;

3. Orthopedic surgery for myopia;

4. qigong therapy, music therapy, health-care nutritional therapy, magnetic therapy and other auxiliary treatment projects.

(5) Other

1. Diagnosis and treatment items of various infertility (pregnancy) and sexual dysfunction;

2. Various scientific research and clinical verification diagnosis and treatment projects;

Urban medical insurance

The following expenses incurred by the insured in designated medical institutions and retail pharmacies are included in the reimbursement scope of the basic medical insurance fund for urban residents:

(1) Medical expenses for hospitalization;

(2) medical expenses within 7 days before emergency observation and hospitalization;

(3) medical expenses that meet the requirements of special diseases in urban residents' outpatient clinics;

(4) other expenses that meet the requirements.

the rest not specified are not included in the reimbursement scope.

Extended information

Medical insurance

First of all, the difference between medical insurance drugs and non-medical insurance drugs, the reimbursement deductible line is also different according to the hospital level

Generally, Class A drugs can enjoy full coverage, and Class C needs to pay all the expenses at its own expense, while Class B needs to pay 8% and pay 2% at its own expense.

If a person spends 1, yuan in a hospital, if he is hospitalized in a first-class hospital, then subtract 5 yuan first; If you are hospitalized in a secondary hospital, subtract 1 yuan first; If you are hospitalized in a tertiary hospital, you will first subtract 2 yuan, which is the difference of deductible.

Resources:

Extended reading: How to buy insurance, which is better, and teach you how to avoid these "pits" of insurance.